Could Lyme disease be another infection associated with the onset of Guillain-Barre Syndrome?

Guillain-Barre Syndrome (GBS) is a life-threatening illness in which the body's immune system attacks the peripheral nervous system. It's characterized by a rapid onset of muscle weakness which can lead to respiratory distress and death. The initial symptoms are typically tingling and weakness in the feet and legs. The exact cause is unknown, but GBS is usually preceded by an infectious illness such as a respiratory infection or stomach flu. While many infections have been associated with GBS, Borrelia burgdorferi, the pathogen causing Lyme disease, has rarely been connected with the syndrome. According to a study by Patel and colleagues, only four cases have been reported in the literature. [1]

However, in their case study Clinical association: Lyme disease and Guillain-Barre Syndrome, the authors highlight “Borrelia burgdorferi as an important antecedent infection associated with the development of GBS,” [1] and describe a 31-year-old man diagnosed with both Lyme disease and GBS. The case raises the question: Could Lyme disease be an underrecognized infectious disease triggering or contributing to the onset of Guillain-Barre Syndrome?

Eight months prior to admission, the man reported having a dime-sized lesion on his left arm. He later developed progressive numbness and weakness in both his hands and feet, along with areflexia. The numbness and burning in his feet progressed to his bilateral upper extremities, and he developed new weakness in all extremities. He also had blurry vision with decreased sensation and numbness in his tongue, and a right temporal headache that worsened with light and sound.

The exam revealed “decreased sensation to pinprick with a distal to proximal gradient up to proximal thigh,” according to Patel from SUNY Upstate Medical University, Syracuse, New York. “Other significant findings were 4/5 weakness in all extremities along with areflexia in biceps, triceps, patellar and achilles.”

Diagnostic testing revealed a mildly high white count of 12,800 WBC/μL, with mildly elevated ESR of 17 mm/h, a spinal tap revealing an elevated protein of 190 mg/dL, and pleocytosis of 10mm3. “An electromyography (EMG) was done showing absent F waves in bilateral tibial and peroneal motor responses consistent evidence of acute, acquired polyradiculoneuropathy with active denervation,” according to Patel. “A clinical picture with ascending neuropathy and EMG findings of isolated absence of F waves favor a diagnosis of GBS.”

A Lyme disease diagnosis was confirmed with immunoblots positive for IgM p23 and p41, as well as IgG p18, p23, p30, p39 and p41. Elevated protein and pleocytosis have been described in neurologic Lyme disease. [2]

The EMG findings, clinical picture and laboratory results were compatible with a diagnosis of Lyme disease and GBS. And the man was prescribed a combination of intravenous immunoglobulin 0.4 g/kg daily, plasma exchange therapy, and intravenous ceftriaxone 2 g. daily. Within 7 days, his symptoms had resolved.

Guillain-Barre Syndrome, the authors point out, “is an immune-mediated polyneuropathy characterized by acute, generalized, ascending peripheral neuropathic weakness with demyelination being the main electrophysiological and pathological feature.” [1] Lyme disease is also associated with demyelination [2] and immune-mediated.

“The actual mechanism between the relationship of GBS and Lyme disease remains unclear,” explains Patel. “However, there is evidence of immune responses associated with tick-borne pathogens. It is possible that these immune complexes in some individuals result in the development of antiganglioside antibodies causing GBS.”


  1. Patel K, Shah S, Subedi D. Clinical association: Lyme disease and Guillain-Barre syndrome. Am J Emerg Med. 2017.
  2. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.

17 Replies to "Could Lyme disease be another infection associated with the onset of Guillain-Barre Syndrome?"

  • Janet
    11/26/2021 (9:12 pm)

    Can chemotherapy cure Lyme disease? My test for the disease showed 6 out of 10 . I had
    HER2 cancer and breast cancer at the same time. Did radiation also. Am now cancer free.
    My hips and legs are losing strength and are baffling my doctors. What specialist should I see?

    • Dr. Daniel Cameron
      11/27/2021 (8:04 am)

      I have not seen any information on the effect of chemotherapy on Lyme disease. I have avoided use of immunosuppressants if I suspect an unresolved tick=borne infection. I have patients in my practice who need to work with their oncologist to rule out a recurrence while they are being treated for a tick-borne infection.

  • Lucy
    01/01/2021 (10:09 pm)

    My daughter is 20 years old and was tested positive for GBS (Steve Miller variant) and Lyme disease in mid-November. Her GBS is severe. She was treated with a 7 day dose of IVIG for the GBS and antibiotics for Lyme. Her recovery has been slow. She’s into her 7th week and she is still on a ventilator with very limited mobility and unable to speak. How can it be determined that Lyme disease is the cause of her condition? Is there a specific antibiotic that works better for treating Lyme disease under these conditions and should she be re-tested for the Lyme.

    • Dr. Daniel Cameron
      01/02/2021 (9:01 am)

      Your daughter’s story highlights the difficulties doctors and their patients have in treatment when Lyme disease and tick borne illnesses are a part of the history. I use IV Rocephin AKA know as IV ceftriaxone as this drugs enters the brain. I have also added oral if needed is I suspect a co-infection. There is no test to determine if Lyme disease has cleared.

  • glen
    12/01/2020 (12:43 pm)

    on june 9th 2020, I had an L 4,5 laminectomy. Everything went great. 8 days later I started feeling tingling in my face. Then the next day move to my legs and feet. I was in a lot of pain so off to the hospital. My health was deteriorating quickly over the next 5 days before figuring out I had gbs. well in ICU I was also diagnosed with lyme disease and West Nile disease. They started 5 days of IVIG treatment, and I was getting better. once I got to rehab, they put a pick line in and started treatment for the lyme. That helped me start walking in a couple weeks. Today is 12/1/2020. I still have a ways to go, but I will get there. Has anyone ever heard of someone getting all 3 diseases at the same time? Thanks for reading.

    • Dr. Daniel Cameron
      12/01/2020 (1:27 pm)

      I am glad the doctors were able to look past GBS. Hopefully, your treatment for Lyme disease will help. I have patients with other tick-borne infections beyond Lyme disease e.g. Anaplasmosis and Babesia. Call my office at 914-666-4665 if you have any questions.

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